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BIOMEDICAL
Treating the Common
Cold and Flu:
Special considerations
for ADHD, ADD, and ASD
BY Kim Gould, RPh, MS
Kim Gould, RPh, MS is the pharmacist in charge at PURE Compounding Pharmacy, an innovative “green” pharmacy located
in Naperville, IL. Kim’s specialty area of pharmacy practice includes compounding prescriptions for ADD, ADHD, and ASD.
T
he “common cold” and the flu have
become such a frequent part of our
seasonal vocabulary that we rarely take
the time to think about the best way to
treat their symptoms. Evaluating treatment
options is especially important in people with
multiple sensitivities such as those who have
symptoms of autism spectrum disorders, ADD,
and ADHD. The “common cold” was named
this way because of its likeness to symptoms
of exposure to the cold weather. The “flu” is
short for “influenza.” Both the cold and flu
are viral respiratory illnesses. The common
cold may be bothersome, but the flu can lead
to more dangerous and severe illness that
can cause death in high risk patients. The
average American child will have 6-10 colds
per year, the average adult 2-4 episodes per
year (Simasek and Blandino, 2007). Flu is less
common, but it also has become part of our acceptance of normal
expected illnesses. Currently, there is not a cure for the common
cold or the flu. Generally, we treat the symptoms of the cold
or flu -- not the virus itself. It is important to note that it is the
symptoms of these viruses and their treatment that differentiate
one from another. In order to have a better understanding of the
two, I have summarized the differences between the cold and the
flu in Table 1.
Cold and Flu Medications
Treating cold and flu symptoms has become a large OTC
(over-the-counter or non-prescription) business. Most drug
and grocery stores have a large section dedicated to these
products. The number of products available to the public is
starting to decrease as the Food and Drug Administration
(FDA) recognizes the problems with safety and efficacy of
these drugs, especially when given to children. In December
2005, the FDA mandated that OTC decongestants containing
phenylpropanolamine become prescription only. Studies showed
72
THE AUTISM FILE | www.autismfile.com an increased incidence of stroke in people
who took phenylpropanolamine. On October
8, 2008, the FDA released an announcement
that manufacturers are voluntarily modifying
all cold/flu products to state “do not use in
children less than 4 years of age.” Experts
reviewing the products think that these
products should not be given to children
under the age of 6, and extreme care should
be given with children under 12-years-old.
Many health care professionals believe greater
measures should be taken while studies on
the safety and effectiveness of these products
are being undertaken. One problem noted by
the FDA is that children are often overdosed
from use of more than one medication at
a time. Improper measurement of the dose
has also posed safety risks. Understanding
the directions and the ingredients and using
the measuring cup that comes with the product may reduce the
incidence of overdosing. The FDA recommends that parents and
caregivers check the active ingredients on the product label.
Parents and caregivers should also check the inactive ingredients
on the label, as both may affect the well-being of a person with
ADD, ADHD, or ASD.
Inactive ingredients such as preservatives, dyes, and other
excipients can cause allergic reactions, such as rash, exacerbation
of asthma symptoms, anaphylaxis, hyperactivity, and, in some
cases, upset stomach and diarrhea. Table 2 lists some of the
inactive ingredients that are commonly added to cold, cough,
and flu products and the adverse reactions that may occur. If you
have a prescription medication for which you would like to know
the inactive ingredients, there are several ways to find out.
First, you can ask your pharmacist to look at the package
insert. Under the title “description” at the very top of the
insert, there is a list of all the ingredients in a manufactured
product.
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ISSUE 30 2009
Cold and Flu Medications
Table 1.
Cold
Flu
Cause
100 known types of cold viruses
Influenza virus, new strains evolve every few years
Symptoms
• Temperature below 101° F
• Starts with a sore throat, watery nasal drainage
(later mucus may thicken and mild cough)
• tiredness but can cope
• Fever, temperature over 101° F
• Aches, pains in muscles and joints
• Headache
• Weakness and fatigue (doesn’t want to get out of bed)
• Vomiting, nausea, diarrhea
• Dry cough
Contagious
Contagious 1 day before symptoms and up to 7 days after
During the first three days of the cold Duration
1-2 weeks (more than that may be allergies) 3-4 days, but cough and tiredness up to 2 weeks after
fever has gone
Symptoms to
worry about
• Fever for greater than 3 days or fever returns
• Cannot stop vomiting or diarrhea (dehydration)
• Wheezing, shortness of breath
• Stiff neck
• Symptoms become worse
• Lower lung pressure
• Stiff neck
• Earache
• Sore throat more than 5 days, fever and sore throat
• Thick yellow/green mucus lasting more than a week with sinus pain may be a sinus infection
Treatments
Treat symptoms (see Table 3 for individual symptoms
• Antiviral medications used within 48 hours will
(see chart for
and treatment). decrease flu symptoms by 1 day
individual symptoms• Treat symptoms (see Table 3 for symptoms and
and treatment) treatment)
Complications
• Secondary bacterial infection
• Secondary bacterial infection
• Sinus and ear infections• Dehydration, sinus and ear infections, must monitor
chronic health problems like diabetes and asthma
PreventionFrequent hand washing; plenty of sleep, hydration, and exercise; well balanced diet. Immune support supplements,
such as vitamin C, zinc, Echinacea, goldenseal, and elderberry, may help. Change your toothbrush after having the
cold or flu so you don’t become reinfected. Use alcohol sanitizers if soap and water are not available.
Second, check a Physicians’ Desk Reference (PDR). The
PDR is a compilation of package inserts printed as a book.
Most libraries and large book stores have a copy of the PDR.
Unfortunately, only the most current high volume prescription
drugs are in the book.
Third, you can look online. Find the official website of the
prescription drug you are checking on. Click on “health care
professional” and then go to the prescribing information
section, which will bring up a copy of the package insert. The
first item listed is the description, and the inactive ingredients
are listed there.
Treating Symptoms
When treating the symptoms of a cold or flu virus, it is best
to look at each symptom and treat it accordingly. When you
administer multi-symptom relief products, you may be giving
unnecessary medications that may have unwanted side effects.
One of the concerns brought to the attention of the FDA
was that children were being given overdoses when parents/
caregivers did not realize the same type of medication was in the
multi-symptom product as in the individual symptom product
that they were giving. If you buy OTC medications to treat
ISSUE 30 2009
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cold and flu symptoms, buy products that have single active
ingredients and as few additives as possible.
Remember that colds and flu are viral infections. Therefore,
antibiotics are not effective against these viral infections and
should not be taken to treat them. When unnecessarily prescribed,
antibiotics can cause resistant organisms, yeast overgrowth, and
immune suppression. When antibiotics are needed for secondary
bacterial infection, probiotics should be used to help maintain a
healthy gut. (Editor’s note: probiotics should not be given at the
same time as the antibiotic dose, but spaced midway between
doses.) The antibiotic Augmentin™ is commonly prescribed for
children with ear infections. It has been reported that Augmentin™
should be avoided in patients with autism, Asperger’s, ADD, or
ADHD due to a potential adverse neurological effect caused by the
clavulanate component of Augmentin™ (Fallon, J 2005).
Table 3 is a list of suggested treatments for common cold and
flu symptoms and what considerations should be given to people
with a diagnosis of autism, ADD, ADHD, or Asperger’s syndrome.
The best approach in treating the symptoms is to look at each
one individually and apply treatments according to each. At the
first sign of symptoms (e.g., sore throat for cold), I like to start
taking zinc and vitamin C and use an herbal blend drop containing
Echinacea, shitake, and noni, which also boosts immunity. Try
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73
BIOMEDICAL
some of the non-medicine interventions if you have not used
them before. Nasal irrigation with saline solution (homemade or
purchased) has become a popular alternative to decongestants.
Warm liquids to drink, inhale or bathe in are very comforting and
therapeutic. A few drops of eucalyptus oil in a bath will help clear a
stuffy nose and head.
Recent studies indicate that some patients’ autistic-like
symptoms may improve during a fever. Children became calmer
and had an improved response to touch and closeness. Although it
is unclear why the improvements occur, it is thought
to be related to an immune system response
(Curran, Newschaffer, et al. 2007). Treating a fever
below 101.5 degrees Fahrenheit with medications
may not be necessary unless underlying medical
issues warrant the use of medicine.
Prevention is always the best medicine for
colds and flu. Practicing good hand washing,
and eating, drinking and sleeping well,
plus a little knowledge about
treatment options will go a long
way. Remember -- with the
exception of using prescription
antiviral medications -- we only
treat the symptoms of cold and
flu, not the virus.
A few medication additives commonly found
in cough, cold, and flu preparations that may
Table 2.
cause adverse reactions
Purpose
Preservative
Additive
Sodium Benzoate
Reported Adverse Effects
• Exacerbation of asthma
(Kumar, Weatherly, et al.,1991).
• Hyperactivity (Bateman,
Benzoic Acids
Warner, et al., 2005).
Parabens
Sweeteners
Aspartame
Hives, angioderma (swelling),
(Nutrasweet™,
cross sensitivity with
Equal™)
sulfonamides, (Kumar, Rawlings,
et al.,1993) hyperactivity when
acting as an excitotoxin
Asthmatic reactions,
brochospasm, pruritis (itching),
uticaria (hives).
(Nagel, Fuscaldo, et al.,1977).
(Boch, 2007).
Increases blood glucose, can
cause hyperactivity.
Sucrose
Saccharin
al.,1993).
Azo Dyes
Hives, itching, nausea, diarrhea,
wheezing, gait disturbances,
skin eruptions, rapid heart
rate, cross sensitivity with
sulfonamides. (Kumar, Rawlings, et
Tartrazine
(FD&C Yellow
5)
Anaphylactoid reactions,
swelling, asthma symptoms,
rash, runny nose, hyperkinesis
in hyperactive patients, cross
reactivity with aspirin and
sodium benzoate.
(Kumar, Rawlings, et al.,1993).
Sunset Yellow
(FD&C Yellow 6)
Anaphylactoid reactions,
swelling, anaphylactic shock,
vasculitis, retching, abdominal
pain, purpura, vomiting,
belching, cross-reactivity with
aspirin, acetaminophen, sodium
benzoate, and other azo dyes
(Kumar, Rawlings et al.,1993).
603 E. Diehl Road, Suite 131, Naperville, Illinois 60563
Ph: (630) 995-4300 or (877) 976-7873
Custom Allergen Free Prescriptions
PURE Compounding Pharmacy meets your needs by making unique
dosage forms that contain ingredients that work for you! We make
prescription medications without allergens or artificial additives. We
prepare prescriptions in many different forms such as liquids, capsules,
suppositories, topical creams and gels.
Bateman, B., Warner, J.O., et al. (2005). The effects
of a double blind placebo controlled, artificial food
colourings and benzoate preservative challenge
on hyperactivity in a general population sample of
preschool children. Arch Dis Child. 90(8):875.
Kumar, A., Rawlings, R. et al. (1993). The mystery
ingredients: sweeteners, flavorings, dyes, and
preservatives in analgesic/antipyretic/antihistamine/
decongestant, cough & cold, antidiarrheal and liquid
theophylline preparations. Pediatrics 1993;91;927-933.
Boch, K. (2007). Healing the New Childhood Epidemics:
Autism, ADHD, Asthma, and Allergies. New York:
Ballantine Books.
Kumar, A., Weatherly, M. et al. (1991) Sweeteners,
flavoring, and dyes in antibiotic preparations. Pediatrics
87(3): 352-360.
Curran, L.K., Newschaffer, C.J., et al. (2007). Behaviors
associated with fever in children with autism spectrum
disorders. Pediatrics 120 (6): e1386-e1392.
Nagel, J., Fuscaldo, J. et al. (1977). Paraben allergy.
JAMA 237(15):1594-5.
We specialize in prescriptions for the treatment of Autism, ADD,
ADHD, Asthma, Allergies, and Colitis. Please call us with your
specialty compounding needs.
Fallon, J. (2005). Could one of the most widely
prescribed antibiotics amoxicillin/clavulanate
Augmentin™ be a risk factor for autism? Medical
Hypothesis 64:312-315.
Our compounded prescriptions are free of dyes, wheat, gluten, corn,
soy, dairy, casein, yeast, stearates, nuts, eggs, shellfish, excitotoxins,
artificial sweeteners, colors or flavors. Our ingredients meet the
highest standards for purity.
Garland, M.L., Hagmeyer K.O. (1998). The role of zinc
lozenges in the treatment of common cold symptoms.
Ann Pharmacother. 32:63-69.
www.purecompounding.com
74
References
THE AUTISM FILE | www.autismfile.com [email protected]
James, S.J., Slikker, W. et al. (2005). Thimerosal
neurotoxicity is associated with glutathione depletion:
protection with glutathione precursors. Neurotoxicology
26(1):1-8.
Pangborn, J., Baker, S.M. (2005). Autism: Effective
Biomedical Treatments. San Diego: Autism Research
Institute.
Simasek, M., Blandino, D.A., (2007). Treatment of
the common cold. American Family Physician, 75
(4):515-520.
Williamson, J.M., Boettcher, B., et al. (1982).
Intracellular cysteine delivery system that protects
against toxicity by promoting glutathione synthesis.
Proc. Natl. Acad. Sci., USA 79:6246-6249.
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ISSUE 30 2009
Treating Symptoms of Cold and Flu Table 3.
Symptom
Treatment
ADD/ADHD/ASD/Asperger’s considerations
Fever, Body Aches,
Headache
Ibuprofen
• Consider having ibuprofen compounded to eliminate dyes, sweeteners and additives.
•Do not use acetaminophen because it decreases glutathione levels (Williamson and
Boettcher, 1982). Glutathione is important in detoxification (Pangborn and Baker, 2005)
and reducing oxidative stress.
• Aspirin may cause Reye’s syndrome if patient has the flu.
•Aspirin and other salicylates can be allergenic and are closely related to phenols. Phenols
can cause cognitive, physical and behavioral problems (Bock, 2007) in people with
sulfation problems.
Congestion
Moist heat
Here are three ways to .
help alleviate congestion
Drink more liquids
without using medications that may cause
hyperactivity. Nasal saline irrigation
or saline nasal sprays
Warm compresses to cheeks and sinuses (you can add 1-2 drops of tea tree oil or eucalyptus
oil in the compress). Warm showers will also open airways and moisten and thin sinus mucus.
Sore Throat
Warm drinks
and gargles
Drinking warm tea with honey (local honey may help with allergies; honey should only be given
in children over age 2) or gargling with warm honey/lemon/water or warm salt water.
Cough
Alternatives to
cough medicines
• Warm tea and honey.
Drink at least 6-8 cups of water each day to help liquefy the mucus that builds up. Warm water
and herbal teas are more effective. Avoid liquids containing caffeine because these may cause
dehydration.
Scientific studies show saline nasal irrigation will thin mucus, decrease post-nasal drip, and
remove virus and bacteria particles from your nose. Xylitol nasal sprays can also be helpful in
humidifying the nasal passage and decreasing nasal irritation.
•Slippery elm (available in lozenges with zinc). Slippery elm has received recognition from
the FDA as a safe and effective treatment for cough and sore throat.
• Cough lozenges made from xylitol and honey (Ricola has a good tasting drop).
•Peppermint thins mucus and will help loosen and break up the phlegm of productive cough.
It is soothing for dry coughs and sore throats. You can use either peppermint teas or candies
(xylitol based).
•There are no over-the-counter cough suppressants available for children under 6-years-old,
and those that are available should be used with caution for children under 12-years-old.
Runny nose, eyes Antihistamines
and sneezing •Dye-free diphenhydramine (some products contain sodium benzoate and saccharin). You
can also have it compounded with a prescription from your doctor. Newer non-drowsy
antihistamines do not work for cold symptoms.
•Quercetin is useful in stopping the production of histamine and inflammation; it is also a
potent antioxidant. The University of Maryland has a great website for complementary
medicine. A use and dosing guideline for Quercetin is available at http://www.umm.
edu/altmed/articles/quercetin-000322.htm
Nausea, vomiting,
Fluids
diarrhea •It is important to replace lost fluids and prevent dehydration. Include a variety of liquids
(not cold because that can upset the stomach more), such as: water, broth, tea, and juices
(watered down may be easier on the stomach).
•The BRAT diet is good until the system settles down (Bananas, Rice, pear sauce [instead of
Applesauce for the child who is limiting phenols], and Toast (gluten free).
Shorten the length of the symptoms • Probiotics help to restore the normal flora in the gut.
(Ed. note: not to be taken at the same time as dose of antibiotics.)
Vitamin C
(ascorbic acid);
zinc lozenges
• Treating with vitamin C when cold symptoms develop will help decrease the length of the cold.
•Studies have shown that zinc lozenges can reduce the length of a cold (Garland and
Hagmeyer, 1998). It may also sooth the throat and reduce coughing. One of my favorite
products is zinc lozenges with slippery elm. Slippery elm has received recognition from the
FDA as a safe and effective treatment.
• Oral zinc liquids and capsules should also be effective in reducing the length of a cold.
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